Integrating quantitative pupillometry into regular care in a neurotrauma intensive care unit. - NeurOptics
pupil, pupil exam, pupil examination, pupil pressure measurement, pupil reaction, pupillary, pupillary light reflex, pupillometer, pupillometry, stroke, TBI, trauma, constriction velocity, critical care, critical care nursing, intraocular pressure, modified rankin scale, neurocritical care, neurologist, neuroscience nursing, neurosurgeon, medical devices, NIH Stroke Scoring Scale, NIHSS, ophth, ophthalmic, ophthalmic surgery, ophthalmologist, ophthalmology, opthal, optometrist to ophthalmologist, PERL
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01 Feb Integrating quantitative pupillometry into regular care in a neurotrauma intensive care unit.

Posted at 21:02h in Critical Care, Critical Care 2 by

Integrating quantitative pupillometry into regular care in a neurotrauma intensive care unit.

 

Category: Critical Care

 

Anderson M, Elmer J, Shutter, L, Puccio A, Alexander S.  Integrating quantitative pupillometry into regular care in a neurotrauma intensive care unit.  J Neurosci Nurs. Vol. 0, Iss. 2018. 0. doi: 10.1097/JNN.0000000000000333

 

Abstract

In the setting of acute traumatic brain injury (TBI), an abnormal pupil assessment may suggest a worsening intracranial lesion. Early detection of pupillary changes may expedite emergent care to improve outcomes. Automated, handheld pupillometers have been commercially available for 20 years, and several studies suggest that their use may facilitate early recognition of worsening injury and intracranial hypertension. The use of pupillometry as a bedside tool in the routine care of patients with severe TBI (Glasgow Coma Scale score e 8) has not been described. We performed a quality improvement project to implement routine use of quantitative pupillometry in our neurotrauma intensive care unit. Nursing staff were trained on device use and the project’s aims in a 30-minute in-service session. Nurses caring for severe TBI patients completed standard pupil assessments using (a) a flashlight and (b) a pupillometer to quantify pupil size and reactivity (Neurological Pupil index) every hour. Abnormal results were reported to on-call providers. We administered surveys to evaluate knowledge, practical use of the pupillometer data, and satisfaction with the device every 3 months. Data were available for 22 nurses at 4 separate time points. Staff were positive about their ability to use and understand the device (H = 8.7 and 9.1, respectively, on a 10-point scale) and reported that it added value to patient care and critical decision-making. Use of automated pupillometry is acceptable to nursing staff in a neurotrauma intensive care unit, and staff believed that pupillometry results enhanced clinical decision-making.

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